Article ID: WMC003513 ISSN 2046-1690
A Series Of Study Of Anatomic Variation On Arterial System
Corresponding Author: Dr. Prakash Baral, Associate Professor, B.P.Koirala Institute Of Health Sciences,Department of Human Anatomy - Nepal
Submitting Author: Dr. Sarun Koirala, Assistant Professor, Department of Human Anatomy, BP Koirala Institute of Health Sciences, 56700 - Nepal
Article ID: WMC003513 Article Type: Original Articles Submitted on:24-Jun-2012, 12:40:17 PM GMT Published on: 26-Jun-2012, 09:14:28 PM GMT Article URL: http://www.webmedcentral.com/article_view/3513 Subject Categories:ANATOMY Keywords:Upper limb, Arterial variation, Axillary, Forearm, Palmar level. How to cite the article:Baral P, Koirala S. A Series Of Study Of Anatomic Variation On Arterial System. WebmedCentral ANATOMY 2012;3(6):WMC003513 Copyright: This is an open-access article distributed under the terms of the Creative Commons Attribution License(CC-BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Source(s) of Funding: None
Competing Interests: Nil
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A Series Of Study Of Anatomic Variation On Arterial System
Author(s): Baral P, Koirala S
Abstract palmar branch of radial artery whereas the radial artery forms the deep palmar arch with the deep branch of ulnar artery.2 Many authors have published different series of reports about arterial anomalies of The arteries supplying the upperlimb exhibit lots of the upper extremities. This article is based on variations. The present study was analyses of series of studies of anatomic variations of conducted on 102 upper limbs of 51 Nepalese bodies ( arterial system of upper limb that was carried out on 30 males and 21 females). The 102 upper limbs. objective was to find out the variations, if any in prevailing branching pattern of arteries in upper limb of Materials and methods Nepalese population. Arterial variation at axillary, arm, forearm and palmar level had been noted. Various types of variation and their clinical implications are One hundreds and two dissected upper limbs discussed. belonging to 51 cadavers (30 males;21 Introduction females) were studied in Anatomy department of Manipal College of Medical Sciences and BP Koirala Institute of Health Sciences. Observations were made and detail findings on arterial Variations in the origin, branching and course of the systems, either normal pattern or variations, were principal arteries of the upper noted down. The observations were made at four extremities have long received the attention of levels: anatomists, surgeons, cardiologists and particularly A. At Axillary level vascular specialists. The arterial pattern of the human B. Arm level upper limbs shown in text books is rarely encountered C. Fore arm level with major and minor variations being well D. Palmar level documented. Often the arterial system of upper limb found in cadaver is very confusing to student because Results of the great variability from the descriptions and illustrations in text books and atlases. Analysis of series of dissections have been recorded but without The types of variations and their frequency in uniformity of results. Normality in anatomy consist of percentage following the observation of range of morphologies that are most typical and others 102 upper limbs: less frequent, which are called variations and not The study result showed that superior thoracic artery considered abnormal.1 The normal arterial system in was absent in 63.7% of total cases. Superior thoracic upper limb is that subclavian artery continues as artery arose from thoracoacromial artery in 3.9% axillary artery from outer surface of first rib. The cases. Common trunk arising from second part of axillary artery gives off superior thoracic artery from its axillary artery and giving of lateral thoracic artery, first part, thoracoacromial and lateral thoracic from its subscapular artery and posterior circumflex humeral second part and subscapular, anterior and posterior artery in 18.7% cases. Posterior circumflex humeral circumflex humeral from third part. Then it becomes artery arose from subscapular artery in 1.8% cases. the brachial artery when it crosses the lower border of Lateral thoracic artery was found from thoracoacromial teres major muscle. Brachial artery gives off profunda artery in 0.9% cases. Subscapular artery from second brachii and radial and ulnar collateral arteries in the part of axillary artery was seen in 0.9% cases. Lateral upper arm. The brachial artery ends in the cubital thoracic artery from subscapular artery was found in fossa dividing into radial and ulnar arteries. Radial 0.9% cases. At arm level high division of brachial artery gives off radial recurrent artery and ulnar artery artery into radial and ulnar artery was found in 4.9% gives off common interosseous and ulnar recurrent cases. Absence of collateral arteries and profunda arteries in the cubital fossa. Ulnar artery forms the brachii continued as muscular branch was seen in superficial palmar arch of the hand with superficial
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0.9% cases. At forearm level communication between origin of superior thoracic artery from thoracoacromial radial and ulnar arteries was existed in 0.9% cases. In artery and also observed the origin of subscapular 12.7% cases there were common interroseous artery artery from second part of axillary artery.11 Gardner E, arising from radial artery. Superficial ulnar artery was Gray DJ, O Rahilly R observed origin of observed in 1.8% cases. Presence of median artery thoracoacromial artery from either first or second part was seen in 0.9% cases. At palmar level superficial of axillary artery.12 Origin of lateral thoracic artery palmar arch was found by ulnar artery alone in 31.3% from thoracoacromial or subscapular arteries is also cases. In 0.9% cases deep palmar arch got no reported in text book of anatomy written by contribution from ulnar artery. Hollinshead WH and Rosse C.13 Patnaik, Kalsey, Singla Rajan K, in their study of 50 upperlimbs of 25 Discussion cadavers, reported the absence of superior thoracic artery in 10% cases.14 De Garis et. al found from their study of arterial variations of upperlimb that circumflex Variations in the arterial anatomy of the upper arteries arose by a common trunk in 8% cases, lateral extremities are quite common.3-6 thoracic from subscapular artery in 6% cases. Muhammad Saeed et.al.observed in 3.8% cases a Superior thoracic from thoracoacromial in 0.01% bilateral common subscapularcircumflex cases and absence of thoracoacromial and various humeral trunk emerging from the 3rd part of the branches arose directly from axillary artery in 0.01% axillary artery and branching cases.15 The present study showed that superior into the circumflex humeral and thoracodorsal arteries thoracic artery was absent in 63.7% of total cases, and in 1.9% cases a bilateral superior thoracic artery arose from thoracoacromial thoracohumeral trunk arising from the 2nd part of the artery in 3.9% cases, common trunk arising from axillary artery and branching into the lateral second part of axillary artery and giving of lateral thoracic,circumflex humeral,subscapular and thoracic artery, subscapular artery and posterior thoracodorsal arteries.7 Durgun et.al also observed,on circumflex humeral artery in 18.7% cases. Posterior right side,the subscapular artery gave rise to a large circumflex humeral artery arose from subscapular posterior circumflex humeral artery in addition to the artery in 1.8% cases. Lateral thoracic artery was found thoracodorsal and circumflex scapular arteries.8 In the from thoracoacromial artery in 0.9% cases. study of Mildred Trotter on 384 arms it was found that Subscapular artery from second part of axillary artery supreme thoracic (superior thoracic) and the was seen in 0.9% cases. Lateral thoracic artery from thoracoacromial originated from the axillary in all but subscapular artery was found in 0.9% cases. five arms; in four of these which were right arms (two B.Durgun et.al also found that radial and ulnar arteries white males, one negro male and one negro female), arose from the brachial artery at the level of arm and the supreme thoracic originated from the also observed the arciform anastomosis between the thoracoacromial and lateral thoracic arose from radial and ulnar arteries.8 Jurjus et.al.,in a case subscapular in 5 white-male axillae (6 percent), in 10 report,found no collateral arteries and profunda artery negro- male axillae (11percent ), in two white-female terminated as muscular branches.16 M.R.Kumar axillae (2 percent), and seven negro- female axillae (8 reported a large median artery arising from the main percent), lateral thoracic arose from the trunk of ulnar artery proximal to the origin of the thoracoacromial in 3 white- male axillae (3 percent), in common interosseous artery.17 Karlsson and one negro-male axillae (1 percent), and in one negro- Niechajev observed high origin of radial artery in female axilla (1 percent). When the posterior 3.47% patients and in 0.43% patients ulnar artery had circumflex came from the subscapular (in fifty-one a high origin from the brachial artery.18 In the present axillae), the lateral thoracic arose from the study, high division of brachial artery into radial and subscapular also in four white- male axillae (8 ulnar artery at arm level was found in 4.9% cases, percent), in five negro-male axillae (10 percent), and in absence of collateral arteries and profunda brachii three negro-female axillae (6 percent); and from the continued as muscular branch was seen in 0.9% thoraco-acromial in three white-male axillae (6 cases and communication between radial and ulnar percent), in three negro-male axillae (6 percent), and arteries was existed in 0.9% cases. Ajay Udayavar in one negro-female axilla (2 percent).9 Bergman reported common interosseous artery arising from et.al.also found the axillary artery giving rise to a radial artey.19 In present study we also reported the common trunk for the subscapular,anterior,and radial artery giving common interosseous artery in posterior humeral circumflex,profunda brachii and 12.7% cases. Fadel RA et.al,Yazar F et.al and Yildrim ulnar arterial collateral arteries.10 BJ Anson reported M et.al reported the Superficial ulnar artery.20-22 In
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present study it was observed in 1.8% cases. Colman 3. Poynter CWM. Congenital anomalies of the arteries and Anson studied the pattern of arterial arches of and veins of the human body with bibliography. hand and found the incomplete superficial palmar University Studies, University of Nebraska 1920; arches in 21.5%cases and in 3%cases there was 22:1-106. incomplete deep palmar arches. The deep palmar 4. McCormack LJ, Cauldwell EW, Anson BJ. Brachial arch was found to be comparatively less variable than and antebrachial arterial patterns: A study of 750 superficial palmar arch.23 In the present study extremities. Surg Gyncecol Obstet 1953; 96: 43-54. superficial palmar arch was found by ulnar artery 5. Huelke DF. Variation in the origins of the branches alone in 31.3% cases and in 0.9% cases deep palmar of the axillary artery. Anat Rec 1959; 35: 33-41. arch formed by radial artery only. This study also 6. Ozan H, Simsek C, Onderoglu S, Kirici Y, Basar R. showed that superficial palmar arch more variable High division of the axillary artery: A rare case of than deep palmar arch in line with Colman and Anson. superficial ulnar artery. Acta Anat (Basel) 1994; 151: 68-70. Clinical Relevance 7. Saeed M, Rufai Amin A, Elsayed Salah E, Sadiq Muhammad S. Variations in the subclavian-axillary arterial system. Saudi Med J 2002; 23(2): 206-12. A thorough knowledge of the vasculature of the axilla 8. Durgun B, Yucel AH, Kizilkant ED, Dere F. Multiple and upper limb is of crucial clinical importance. The arterial variation of the human upper limb. Surg Radiol upper limb is frequently the site of trauma and other Anat 2002; 24: 125-28. pathology like frequent abscess formation in axilla, 9. Trotter M, Henderson JL, Gass H et al. The origins space infection of palmar spaces, and various joint of branches of the axillary artery in whites and in disease in joints of upper limb which all require American negroes. Anat Record 1930; 46:133-37. interventions that demand of proper anatomical 10. Bergman RA, Thompson SA, Afifi AK, Saadeh FA. knowledge, especially of its regional blood vessels and Compendium of human anatomic variation. Munich: lymphatics as well as their possible variations. Axillary Urban and Schwarzenberg 1988; 72-73. lymph node dissections is an important part of many 11. Anson BJ. Morris Human Anatomy, 12th ed. cancer operations, particularly those involving removal Berkeley: McGraw-Hill Inc. 1966; 708-24. of breast.24 Surgeons should make every effort to 12. Gardner E, Gray DJ, O Rahilly R. Anatomy: A preserve and protect, among other structures, the Regional study of Human structure, 5th ed. axillary artery and vein. Anomalous origin and Philadelphia: W.B. Saunders Company 1986; 107-8. distribution of the arteries in upper limb make them 13. Hollinshead WH, Rosse C. Text book of Anatomy. more vulnerable to trauma during surgery. Such 4th ed. Philadelphia: Harper and Row publishers aberrations may cause difficulty for cardiologists in Inc.1985; 187-9. catheterization of the artery25,26 for radiologists in 14. Patnaik VVG, Kalsey G, Singla Rajan K. Branching making radiological diagnosis, surgeons especially pattern of axillary artery – A morphological study. J during raising the myocutaneous flap for surgical Anat Soc India 2000; 49(2) 127-32. reconstruction and orthopaedic surgeons while dealing 15. DeGaris CF and Swartley WB. The axillary artery with trauma and disease of joints and bones of upper in white and negro stocks. Am J Anat 1928; 41:353. limb. Therefore both the normal and variant anatomy 16. Jurjus AR, Sfeir RE, Bezirdjian R. Unusual of the region should be well known for accurate variation of the arterial pattern of the human upper diagnosis, better treatment and avoidance of limb. Anat Rec 1986; 215: 82-3. iatrogenic injuries during interventional vascular 17. Kumar MR. Multiple arterial variations in the upper procedures. limb of a south Indian female cadaver. Clin Anat 2004; 17: 233-35. References 18. Karlsson S, Niechajev IA. Arterial anatomy of the upper extremity. Acta Radiol 1982; 23:115-21. 19. Udayavar A. Anomalous termination of the brachial 1. Willian PL, Humpherson JR. Concept of variation artery. J Anat Soc India 2004; 53:41. and normality in morphology: important issues at risk 20. Fadel RA, Amonoo-Kuofi HS. The superficial ulnar of neglect in modern undergraduate medical courses. artery: development and surgical Clin Anat 1999; 12:185-190. significance.Clin Anat1996; 9:128-32. 2. Hollinshead WH. Anatomy for surgeons. 3rd ed. 21. Yazar F, Kirci Y, Ozan H, Aldur MM. An unusual Vol.3. Philadelphia: Harper and Row 1982; 285-93 : variation of the superficial ulnar artery. Surg Radiol 359-60. Anat1999; 21:155-57.
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22. Yildrim M, Kopuz C, Yildiz Z. Report of a rare human variation:the superficial ulnar artery arising from the axillary artery. Okajimas Folia Anat Jpn 1999; 76:187-91. 23. Coleman S, Anson J. Arterial pattern in hand based upon a study of 650 specimens. Surg Gynaecol Obstet 1961; 96:43-54. 24. Anson BJ, Wright RR, Wolfer JA. Blood supply of the mammary gland. Surg Gynecol Obstet 1939; 69:468 - 73. 25. Eascott HHG. Arterial Surgery. 3rded. Edinburg: Churchill Livingstone 1992; 342-97. 26. Magee A, Sim E, Benson LN, Williams WG, Trusler Freedom RM. Augmentation of pulmonary blood with an axillary arteriovenous fistula after a cavopulmonary shunt. J Thoracic Cardiovasc Surg 1996; 111: 176-80
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Illustrations
Illustration 1
A Common trunk from third part of Axillary artery giving rise to lateral thoracic, Subscapular and continuing as posterior circumflex humeral artery.
Illustration 2
Higher division of brachial artery into radial and ulnar arteries.
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